Treatment in Little Rock?

Our second meeting with oncologist Dr. B was less than satisfactory. He advised us that, since this was an "incurable" disease and Don wasn't symptomatic at this time, there was no need to begin chemotherapy. For two nurse practitioners, this was a difficult message to swallow. Don's orientation from emergency care was diagnose and treat (NOW!). Dr B's delivery was factual and clinical. He cautioned us to wait for the genetic studies, which would be available in another 2-3 weeks.

Don checked regularly with the oncology center regarding his genetic studies. When they were available, they faxed them to him at his request. Dr. B. called us home this evening. Don has a genetic profile that is "associated with poor prognosis" (deletion of Chromosome 13, with hypodiploid presentation). I had done enough research on the internet to know that this type of MM was resistant to chemotherapy and fraught with frequent relapse. Mean survival was 3-5 yrs, depending on the clinical condition at the time of diagnosis. Dr. B was very supportive on the phone. He answered questions and told us he wanted to start Don on Zometa to strenghten his bones.

We met him in the office two days later and discussed treatment options. There are two major research centers for MM in our region: MD Anderson Cancer Center in Houston and UAMS in Little Rock. Dr. B encouraged us to get a second opinion from UAMS, since most oncologists in the DFW area would follow MD Anderson protocols. Besides, UAMS is doing more work with genetics than anyone else in the country. They have a huge database of genetic information that maps gene type to treatment outcome, thereby providing more precise approaches.

Dr. B arranged the referral to UAMS. The next challenge was getting insurance approval for the visit, since the facility is out of our PPO network. After several phone calls and a letter from Dr. B, the insurance approved three visits at in network rates before the end of the year.